The most contentious question has been what to do in the old county of Dyfed, which at the moment has three large hospitals.

There is still a long way to go in shaping the detail of what each individual service will look like in the future

Dr Bruce Ferguson, review board

The idea of centralising services to one main "super hospital" halfway between Withybush in Haverfordwest and the West Wales General in Carmarthen triggered marches in Haverfordwest and Aberystwyth, uniting staff and patients.

Community health councils (CHCs) in Carmarthenshire and Pembrokeshire criticised the proposals, saying they lacked "meaningful and significant detail".

They said many patients would travel greater distances and predicted strong and vocal opposition from the public ahead of the public consultation.

On Monday, the board said it had listened and was offering a way forward by creating a new planning forum for decisions that would be the first step in a "10-year process of change".

Single hospital

The board recommended that the trusts in Pembrokeshire, Carmarthenshire and Ceredigion are merged to form one trust, known as Dyfed.

But it would not make any recommendation on whether there should be a central hospital for the three counties, until it has more information.

Bruce Ferguson, one of the senior doctors on the project team, said: "There is still a long way to go in shaping the detail of what each individual service will look like in the future.

"But the Project Board has been very reassured by the degree of clinical and public support for the underlying principles."

Elsewhere, there will be sweeping changes, with the recommendation that two of Wales' largest hospitals, Morriston and Singleton, be replaced by one single hospital in Swansea.

The new hospital would cost around £500m to build but is unlikely to provide the same number of beds.

The review board's recommendations will now be voted on by local health boards.

'Grasping the nettle'

Mike Ponton, director of the Welsh NHS Confederation, said: "Proposals for redesigning heath services are being considered not only in mid and West Wales but across Wales, the UK and Europe.

"Grasping the nettle now will lead to real improvements in healthcare and people's health. Shying away from the difficult decisions will only temporarily avoid change that is inevitable and unavoidable."

She said: "More detail needs to be provided on how primary care services and community care services will be improved under the local health boards' plans.

"Their proposals which focussed mainly on cutting hospital services would have made it more difficult for many residents in west Wales in accessing the NHS, which is why local health boards should come back with a much more detailed set of proposals for the delivery of health services that will not disadvantage the residents of mid and west Wales."